Citation Nr: 0721727
Decision Date: 07/19/07 Archive Date: 08/02/07
DOCKET NO. 05-23 161 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Waco, Texas
THE ISSUES
1. Entitlement to service connection for hypertension.
2. Entitlement to service connection for epistaxis or
nosebleeds.
3. Entitlement to service connection for skin disease.
4. Entitlement to service connection for sleeplessness or
restlessness.
5. Entitlement to service connection for urinary tract
infections.
6. Entitlement to service connection for a temper condition.
7. Entitlement to service connection for tinnitus.
8. Entitlement to service connection for a joint pain of the
shoulders, fingers, and knees.
ATTORNEY FOR THE BOARD
J. Horrigan, Counsel
INTRODUCTION
The veteran, who is the appellant, retired from active duty
in January 1982 after more than 20 years of service.
This matter is before the Board of Veterans' Appeals (Board)
on appeal of a rating decision in January 2005 of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Waco, Texas.
FINDINGS OF FACT
1. Hypertension was not affirmatively shown to have had onset
during service; hypertension was not manifested to a
compensable degree within one year from the date of
separation from service; and hypertension, first diagnosed
after service beyond the one-year presumptive period, is
unrelated to an injury, disease, or event of service origin.
2. Epistaxis or nosebleeds were not affirmatively shown to
have had onset during service; epistaxis or nosebleeds first
diagnosed after service are unrelated to an injury, disease,
or event of service origin.
3. Skin disease, fungal infection of the feet, was not
affirmatively shown to have had onset during service; skin
disease, fungal infection of the feet, first diagnosed after
service is unrelated to an injury, disease, or event of
service origin.
4. A disability manifested by sleeplessness or restlessness
is not currently shown.
5. Chronic urinary tract infections are not currently shown.
6. A temper condition is not currently shown.
7. Tinnitus was not affirmatively shown to have had onset
during service, and tinnitus, first documented after service,
is unrelated to an injury, disease, or event of service
origin.
8. Joint pain of the shoulders, arthritis established by X-
rays, was not affirmatively shown to have had onset during
service; joint pain, arthritis of the shoulders, was not
manifested to a compensable degree within one year from the
date of separation from service; joint pain, arthritis of the
shoulders, first diagnosed after service, is unrelated to an
injury, disease, or event of service origin; and joint pain
of the fingers and knees is not currently shown.
CONCLUSIONS OF LAW
1. Hypertension was not incurred in or aggravated during
service, and hypertension as a chronic disease may not be
presumed to have been incurred during service. 38 U.S.C.A.
§§ 1110, 1112, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303,
3.307, 3.309 (2006).
2. Epistaxis or nosebleeds are not due to an injury or
disease that was incurred in or aggravated by service. 38
U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2006).
3. Skin disease, a skin infection of the feet, is not due to
an injury or disease that was incurred in or aggravated by
service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §
3.303 (2006).
4. A disability manifested by sleeplessness or restlessness
is not due to an injury or disease that was incurred in or
aggravated by service. 38 U.S.C.A. §§ 1110, 1131
(West 2002); 38 C.F.R. § 3.303 (2006).
5. Chronic urinary tract infections are not due to an injury
or disease that was incurred in or aggravated by service. 38
U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2006).
6. A temper condition is not due to an injury or disease that
was incurred in or aggravated by service. 38 U.S.C.A. §§
1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2006).
7. Tinnitus is not due to an injury or disease that was
incurred in or aggravated by service. 38 U.S.C.A. §§ 1110,
1131 (West 2002); 38 C.F.R. § 3.303 (2006).
8. Joint pain of the shoulders, fingers, and knees is not due
to an injury or disease that was incurred in or aggravated by
service; and arthritis of the shoulders as a chronic disease
may not be presumed to have been incurred during service.
38 U.S.C.A. §§ 1110, 1112, 1131, 1137 (West 2002); 38 C.F.R.
§§ 3.303, 3.307, 3.309 (2006).
The Veterans Claims Assistance Act of 2000 (VCAA)
The VCAA, codified in part at 38 U.S.C.A. §§ 5103, 5103A, and
implemented in part at 38 C.F.R § 3.159, amended VA's duties
to notify and to assist a claimant in developing information
and evidence necessary to substantiate a claim.
Duty to Notify
Under 38 U.S.C.A. § 5103(a), VA must notify the claimant of
the information and evidence not of record that is necessary
to substantiate the claim, which information and evidence VA
will obtain, and which information and evidence the claimant
is expected to provide. Under 38 C.F.R. § 3.159, VA must
request that the claimant provide any evidence in the
claimant's possession that pertains to the claim.
The VCAA notice requirements apply to all five elements of a
service connection claim. The five elements are: 1) veteran
status; 2) existence of a disability; (3) a connection
between the veteran's service and the disability; 4) degree
of disability; and 5) effective date of the disability.
Dingess v. Nicholson, 19 Vet. App. 473 (2006).
The VCAA notice must be provided to a claimant before the
initial unfavorable adjudication by the RO. Pelegrini v.
Principi, 18 Vet. App. 112 (2004).
The RO provided pre- and post-adjudication VCAA notice by
letter, dated in July 2004 and in March 2006. The veteran
was notified of the evidence needed to substantiate the
claims of service connection, namely, evidence of current
disability, evidence of an injury or disease in service or
event in service, causing injury or disease; and evidence of
a relationship between the current disability and the injury,
disease, or event in service. The veteran was notified that
VA would obtain service records, VA records, and records of
other Federal agencies and that he could submit private
medical records or authorize VA to obtain private medical
records on his behalf. He was asked to submit any evidence
that would include that in his possession. The notice
included the degree of disability assignable and the general
effective date provision for the claims, that is, the date of
receipt of the claims.
As for content of the VCAA notice, the documents
substantially complied with the specificity requirements of
Quartuccio v. Principi, 16 Vet. App. 183 (2002) (identifying
evidence to substantiate a claim and the relative duties of
VA and the claimant to obtain evidence); of Charles v.
Principi, 16 Vet. App. 370 (2002) (identifying the document
that satisfies VCAA notice); of Pelegrini v. Principi,
18 Vet. App. 112 (2004) (38 C.F.R. § 3.159 notice); and of
Dingess v. Nicholson, 19 Vet. App. 473 (notice of the
elements of the claim).
To the extent that the degree of disability assignable was
provided after the initial adjudication, the timing of the
notice did not comply with the requirement that the notice
must precede the adjudication. As the claims of service
connection are denied, no disability rating can be awarded as
a matter of law and therefore there is no possibility of any
prejudice to the veteran with respect to the timing error as
to degree of disability assignable. Sanders v. Nicholson,
487 F.3d 881 (Fed. Cir. 2007).
Duty to Assist
Under 38 U.S.C.A. § 5103A, VA must make reasonable efforts to
assist the claimant in obtaining evidence necessary to
substantiate the claims. The RO has obtained the service
medical records, VA records, and private medical records. As
there is no indication of the existence of additional
evidence to substantiate the claims, the Board concludes that
the duty-to-assist provisions of the VCAA have been complied
with.
The veteran has been afforded a VA examination for tinnitus.
The veteran has not been afforded VA examinations for the
hypertension or epistaxis or nosebleeds because there is no
evidence that establishes that the veteran suffered an
injury, disease, or event in service associated with the
claimed disabilities. Also the veteran has not been afforded
VA examinations for skin disease or joint pain of the
shoulders because there is no indication that the claimed
disabilities may be associated with an established injury,
disease, or event in service. And the veteran has not been
afforded VA examinations for sleeplessness or restlessness,
urinary tract infections, a temper condition, and joint pain
of the fingers and knees because there is no competent
evidence of current diagnoses. Under these circumstances,
a medical examination or medical opinion is not required
under 38 C.F.R. § 3.159(c)(4).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
Factual Background
The service medical records, including the reports of
examinations for entrances to active duty, re-enlistments,
separations, and retirement contain no complaint, finding, or
history of hypertension, epistaxis or nosebleeds,
sleeplessness or restlessness, a temper condition, tinnitus,
or joint pain of the fingers and knees. When reported the
diastolic blood pressure readings were predominantly below 90
mm. and the systolic blood pressure readings were
predominantly 140 mm. On retirement examination blood
pressure was 120/80.
The service medical records do show that in June, July, and
August 1970 the veteran complained of a skin rash, which
involved the genitalia. The rash was not otherwise
identified. The skin was evaluated as normal on retirement
examination.
The service medical records also show that the veteran was
treated for urinary tract infections, namely, nonspecific
urethritis (November 1961, April 1964, and November 1973),
acute urethritis (October 1962), recurrent urinary tract
infection (July and October 1970), and rule out an urinary
tract infection (June 1979). The genitourinary evaluation on
retirement examination was normal.
The service medical records also show that in January 1981
the veteran complained of left shoulder pain. There was no
history of trauma. The assessment was muscle pain. On
retirement examination, the upper extremities were evaluated
as normal.
After service, private medical records disclose that in March
1986 the veteran had reconstructive nasal surgery because of
nasal bleeding, which had persisted for about three months.
There was no history of nasal trauma or other past bleeding
tendency. The diagnosis was persistent epistaxis.
Private medical records also show that in November 1994
hypertension was diagnosed. In February 1998 the veteran
complained of ringing in the ears. In December 2001, he
complained of ringing in the right ear of two weeks duration.
VA records disclose that in January 1997 the veteran
complained micturition. In January 2003, X-rays revealed
degenerative arthritis of the shoulders. In April 2004, a
possible urinary tract infection was noted. In September
2004 and March 2005, the veteran was treated for a skin
infection of the right foot. In March 2005, the veteran also
complained of tinnitus.
On VA examination in December 2005, the veteran gave a 22
year history of noise exposure in the military. The veteran
stated that tinnitus began in 2000 as a result of ear
infection and he denied experiencing tinnitus during military
service. At the conclusion of the evaluation, the examiner
expressed the opinion that the veteran's tinnitus was less
likely than not related to military noise exposure.
Principles of Service Connection
Service connection may be granted for a disability resulting
from an injury or disease incurred or aggravated in military
service. 38 U.S.C.A. §§ 1110, 1131.
Service connection means that the facts, shown by evidence,
establish that a particular injury or disease resulting in
disability was incurred coincident with service, or if
preexisting such service, was aggravated by service. This
may be accomplished by affirmatively showing inception or
aggravation during service. 38 C.F.R. § 3.303(a).
For the showing of chronic disease in service there is
required a combination of manifestations sufficient to
identify the disease entity and sufficient observation to
establish chronicity at the time, as distinguished from
merely isolated findings or a diagnosis including the word
"chronic." Continuity of symptomatology is required where
the condition noted during service is not, in fact, shown to
be chronic or where the diagnosis of chronicity may be
legitimately questioned. When the fact of chronicity in
service is not adequately supported, then a showing of
continuity after discharge is required to support the claim.
38 C.F.R. § 3.303(b).
Service connection may also be warranted for any disease
diagnosed after discharge, when all the evidence, including
that pertinent to service, establishes that the disease was
incurred in service. 38 C.F.R. § 3.303(d).
If a veteran served 90 days or more on active duty, service
incurrence will be presumed for certain chronic diseases,
including hypertension or arthritis, if the disease becomes
manifest to a compensable degree within the year after
service. 38 U.S.C.A. §§ 1112, 1137; 38 C.F.R. §§ 3.307,
3.309.
The term hypertension means that the diastolic blood pressure
is predominantly 90 mm. or greater, or the systolic blood
pressure is predominantly 160 mm. or greater with a diastolic
blood pressure of less than 90 mm. 38 C.F.R. § 4.104,
Diagnostic Code 7101.
Analysis
Hypertension
On the basis of the service medical records, in the absence
of any clinical finding or diagnosis of hypertension,
hypertension was not affirmatively shown to have had onset
during service. 38 U.S.C.A. §§ 1110, 1131; 338 C.F.R.
§ 3.303(a).
And as there is no competent evidence either contemporaneous
with or after service that hypertension was otherwise noted,
that is, observed during service, the principles of service
connection pertaining to chroncity and continuity of
symptomatology under 38 C.F.R. § 3.303(b) do not apply.
Savage v. Gober, 10 Vet. App. 488, 495-96 (1997).
The record does show that after service hypertension was
first documented in 1994, 12 years after retirement from
service in 1982 and well beyond the one-year presumptive
period for hypertension as a chronic disease under
38 U.S.C.A. §§ 1112, 1137; 38 C.F.R. §§ 3.306, 3.309.
Under 38 C.F.R. § 3.304(d), service connection may also be
warranted for any disease diagnosed after discharge, when all
the evidence, including that pertinent to service,
establishes that the disease was incurred in service. And
while hypertension was first documented after service, beyond
the one-year presumptive period for the manifestation of
hypertension as a chronic disease, there is no competent
medical evidence that links the current hypertension to
service.
As for the veteran's statements, relating hypertension to
service, where, as here, the determinative issue involves a
question of medical diagnosis or of medical causation,
competent medical evidence is required to substantiate the
claim. The veteran as a layperson is not competent to offer
an opinion on a medical diagnosis or on medical causation,
and consequently his statements do not constitute favorable
medical evidence to substantiate the claim. Grottveit v.
Brown, 5 Vet. App. 91, 93 (1993).
As the Board may consider only independent medical evidence
to support its finding and as there is no favorable medical
evidence to support the claim of service connection for
hypertension as articulated above, the preponderance of the
evidence is against the claim and the benefit-of-the-doubt
standard of proof does not apply. 38 U.S.C.A. § 5107(b).
Epistaxis or Nosebleeds
On the basis of the service medical records, in the absence
of any clinical finding or diagnosis of epistaxis or
nosebleeds, epistaxis or nosebleeds were not affirmatively
shown to have had onset during service. 38 U.S.C.A. §§ 1110,
1131; 338 C.F.R. § 3.303(a).
And as there is no competent evidence either contemporaneous
with or after service that epistaxis or nose bleeds were
otherwise noted, that is, or observed during service, the
principles of service connection pertaining to chroncity and
continuity of symptomatology under 38 C.F.R. § 3.303(b) do
not apply. Savage v. Gober, 10 Vet. App. 488, 495-96 (1997).
The record does show that after service epistaxis or
nosebleeds were as first documented in 1986, 4 years after
retirement from service in 1982. At the time, there was
about a three month history of persistent nosebleeds and no
history of other past bleeding tendency. Under 38 C.F.R.
§ 3.304(d), service connection may be warranted for any
disease diagnosed after discharge, when all the evidence,
including that pertinent to service, establishes that the
disease was incurred in service. As there is no competent
medical evidence that links epistaxis or nosebleeds, first
documented after service, to an injury, disease, or event,
resulting in injury or disease, of service origin, service
connection under 38 C.F.R. § 3.303(d) is not established.
As for the veteran's statements, relating epistaxis or
nosebleeds to service, where, as here, the determinative
issue involves a question of medical diagnosis or of medical
causation, competent medical evidence is required to
substantiate the claim.
The veteran as a layperson is not competent to offer an
opinion on a medical diagnosis or on medical causation, and
consequently his statements do not constitute favorable
medical evidence to substantiate the claim. Grottveit v.
Brown, 5 Vet. App. 91, 93 (1993).
As the Board may consider only independent medical evidence
to support its finding and as there is no favorable medical
evidence to support the claim of service connection for
epistaxis or nosebleeds as articulated above, the
preponderance of the evidence is against the claim and the
benefit-of-the-doubt standard of proof does not apply.
38 U.S.C.A. § 5107(b).
Skin Disease
Over a three-month period in 1970, the service medical
records document the veteran's complaint of skin rash that
was not associated with a clinical assessment or diagnosis.
There were no other skin complaints during the remainder of
the veteran's service, and the skin was evaluated as normal
on retirement examination. The complaint of a skin rash that
was not otherwise identified over a short period of time is
insufficient to identify the disease entity and there was
insufficient observation to establish chronicity at the time.
Since the fact of chronicity in service was not adequately
supported by the service medical records, then a showing of
continuity of symptomatology after service is required to
support the claim.
After service, a skin infection, involving the feet, was
first documented in September 2004, more than 20 years after
service. The period without documented complaints of a skin
symptoms from 1982 to 2004 is evidence against continuity of
symptomatology. 38 C.F.R. § 3.303(b); Maxson v. West, 12
Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v Gober, 230
F.3d 1330, 1333 (Fed. Cir. 2000) (It was proper to consider
the veteran's entire medical history, including a lengthy
period of absence of complaints.). And although a skin
infection was documented after service, there is no competent
medical evidence that links the current skin infection to an
injury, disease, or event, resulting in an injury or disease
or injury, of service origin to establish service connection
under 38 C.F.R. § 3.304(d), considering all the evidence,
including that pertinent to service.
As for the veteran's statements, relating his current skin
condition to service, where, as here, the determinative issue
involves a question of medical diagnosis or of medical
causation, competent medical evidence is required to
substantiate the claim. The veteran as a layperson is not
competent to offer an opinion on a medical diagnosis or on
medical causation, and consequently his statements do not
constitute favorable medical evidence to substantiate the
claim. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993).
As the Board may consider only independent medical evidence
to support its finding and as there is no favorable medical
evidence to support the claim of service connection for skin
disease as articulated above, the preponderance of the
evidence is against the claim and the benefit-of-the-doubt
standard of proof does not apply. 38 U.S.C.A. § 5107(b).
Sleeplessness and Restlessness
Neither sleeplessness nor restlessness was documented during
service. And the record does not show a current disability
that is manifested by either sleeplessness or restlessness.
In the absence of proof of a present disability, there can be
no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225
(1992). For this reason, the preponderance of the evidence
is against the claim and the reasonable-doubt standard of
proof does not apply. 38 U.S.C.A. § 5107(b).
As the Board may consider only independent medical evidence
to support its finding and as there is no favorable medical
evidence to support the claim of service connection for
sleeplessness or restlessness, the preponderance of the
evidence is against the claim and the benefit-of-the-doubt
standard of proof does not apply. 38 U.S.C.A. § 5107(b).
Urinary Tract Infections
Over a period of more than twenty years, the service medical
records do document urinary tract infections in 1961, 1962,
1964, 1970, and 1973 that were variously clinically
identified as either non-specific, acute, or on one occasion
recurrent, but the genitourinary evaluation on retirement
examination was normal. Because there was only a single
reference to a recurrent urinary tract infection and as the
other references were to either non-specific or acute
infections, the service medical records are insufficient to
identify the disease entity and there was insufficient
observation to establish chronicity at the time.
Since the fact of chronicity in service was not adequately
supported by the service medical records, then a showing of
continuity of symptomatology after service is required to
support the claim.
After service, there is a single complaint of micturition in
1997, 25 years after service. The period without documented
complaints of symptoms of urinary infection from 1982 to 1997
is evidence against continuity of symptomatology. 38 C.F.R.
§ 3.303(b); Maxson v. West, 12 Vet. App. 453, 459 (1999),
aff'd sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed.
Cir. 2000) (It was proper to consider the veteran's entire
medical history, including a lengthy period of absence of
complaints.). And although urinary tract infections were
documented during service, there is no competent medical
evidence of chronic urinary tract infection after service.
In the absence of proof of a present disability, there can be
no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225
(1992).
As the Board may consider only independent medical evidence
to support its finding and as there is no favorable medical
evidence to support the claim of service connection for
urinary tract infections as articulated above, the
preponderance of the evidence is against the claim and the
benefit-of-the-doubt standard of proof does not apply.
38 U.S.C.A. § 5107(b).
A Temper Condition
A temper condition was not documented during service. And
the record does not show a current disability that is
manifested by a temper condition. In the absence of proof of
a present disability, there can be no valid claim. Brammer
v. Derwinski, 3 Vet. App. 223, 225 (1992). For this reason,
the preponderance of the evidence is against the claim and
the reasonable-doubt standard of proof does not apply.
38 U.S.C.A. § 5107(b).
As the Board may consider only independent medical evidence
to support its finding and as there is no favorable medical
evidence to support the claim of service connection for a
temper condition, the preponderance of the evidence is
against the claim and the benefit-of-the-doubt standard of
proof does not apply. 38 U.S.C.A. § 5107(b).
Tinnitus
On the basis of the service medical records, in the absence
of any clinical finding or diagnosis of tinnitus, tinnitus
was not affirmatively shown to have had onset during service.
38 U.S.C.A. §§ 1110, 1131; 338 C.F.R. § 3.303(a).
And as there is no competent evidence either contemporaneous
with or after service that tinnitus was otherwise noted, that
is, observed during service, the principles of service
connection pertaining to chroncity and continuity of
symptomatology under 38 C.F.R. § 3.303(b) do not apply.
Savage v. Gober, 10 Vet. App. 488, 495-96 (1997).
The record does show that after service tinnitus was first
documented in 1998, 16 years after the veteran retired from
service in 1982. The remaining question is whether service
connection may be granted for tinnitus diagnosed after
service, considering all the evidence, including that
pertinent to service.
On this question, the evidence of record consists of a report
of a VA examiner, who expressed the opinion that the
veteran's tinnitus was less likely than not related to
military noise exposure. This evidence is uncontroverted.
As the Board may consider only independent medical evidence
to support its finding and as there is no favorable medical
evidence to support the claim of service connection for
tinnitus as articulated above, the preponderance of the
evidence is against the claim and the benefit-of-the-doubt
standard of proof does not apply. 38 U.S.C.A. § 5107(b).
Joint Pain of the Shoulders, Fingers, and Knees
Left shoulder pain was documented in service in January 1981.
There was no history of trauma, and the assessment was muscle
pain. On retirement examination, the upper extremities were
evaluated as normal. The single complaint of shoulder pain
is insufficient to identify the disease entity and there was
insufficient observation to establish chronicity at the time.
Since the fact of chronicity in service was not adequately
supported by the service medical records, then a showing of
continuity of symptomatology after service is required to
support the claim.
After service, VA records disclose that in January 2003 X-
rays revealed degenerative arthritis of the shoulders, 21
years after retirement from service in 1982 and well beyond
the one-year presumptive period for arthritis as a chronic
disease under 38 U.S.C.A. §§ 1112, 1137; 38 C.F.R. §§ 3.306,
3.309.
The period without documented complaints of shoulder pain
from 1982 to 2003 is evidence against continuity of
symptomatology. 38 C.F.R. § 3.303(b); Maxson v. West, 12
Vet. App. 453, 459 (1999), aff'd sub nom. Maxson v Gober, 230
F.3d 1330, 1333 (Fed. Cir. 2000) (It was proper to consider
the veteran's entire medical history, including a lengthy
period of absence of complaints.).
And although arthritis was documented after service, there is
no competent medical evidence that links the current
arthritis of the shoulders to a disease, injury, or event,
resulting in disease or disease, of service origin to
establish service connection under 38 C.F.R. § 3.304(d),
considering all the evidence, including that pertinent to
service. And pain alone does not constitute a disability for
which service connection may be granted in the absence of a
factual showing that the pain derives from an in-service
injury or disease, which is not shown. Sanchez-Benitez v.
West, 259 F.3d 1356 (Fed. Cir. 2001).
Joint pain of the fingers and knees was not documented during
service. And the record does not show a current disability
that is manifested by a joint pain of the fingers or knees.
Pain alone does not constitute a disability for which service
connection may be granted in the absence of a factual showing
that the pain derives from an in-service injury or disease,
which is not shown. Sanchez-Benitez v. West, 259 F.3d 1356
(Fed. Cir. 2001). In the absence of proof of a present
disability, there can be no valid claim. Brammer v.
Derwinski, 3 Vet. App. 223, 225 (1992).
As the Board may consider only independent medical evidence
to support its finding and as there is no favorable medical
evidence to support the claim of service connection for joint
pain of the shoulders, fingers and knees, the preponderance
of the evidence is against the claim and the benefit-of-the-
doubt standard of proof does not apply. 38 U.S.C.A. §
5107(b).
ORDER
Service connection for hypertension is denied.
Service connection for epistaxis or nosebleeds is denied.
Service connection for skin disease is denied.
Service connection for sleeplessness or restlessness is
denied.
Service connection for urinary tract infections is denied.
Service connection for a temper condition is denied.
Service connection for tinnitus is denied.
Service connection for joint pain of the shoulders, fingers,
and knees is denied.
______________________________________________
GEORGE E. GUIDO JR.
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs